Training

STD/AIDS Research Training Fellowship Program

Public Health and Epidemiology Track

H. Hunter Handsfield, MD, Laura A. Koutsky, PhD, Co-Directors

Overview: The Public Health and Epidemiology track, developed in collaboration with the Department of Epidemiology, School of Public Health and Community Medicine, trains postdoctoral (MPH) and predoctoral (PhD) fellows for academic careers in research, teaching, and clinical care and public health STD and HIV prevention. The MPH/PhD component of the track fulfills the need for systematic clinical-epidemiologic methodological training among physician investigators in this and other tracks; and provides talented pre-doctoral students training in both biomedical and methodological aspects of STD/HIV prevention research. There is no shortage of qualified candidates for this track. During the last several years, STD/HIV has been the number one area of interest among applicants to the graduate program in epidemiology with about 25% of the 40 to50 students enrolled each year planning to pursue an STD/HIV-related research topic. Trainees participate in the STD and AIDS Core Curriculum, and also in: 1) course-work and thesis leading to an MPH or PhD in epidemiology (degree requirements outlined in "Department of Epidemiology, School of Public Health and Community Medicine, University of Washington Ð Epidemiology Program Guidelines" clinical, epidemiologic, and STD/HIV prevention research; and 3) preceptorships with faculty consultants in public health STD/HIV epidemiology and prevention programs.

Pre-doctoral students in epidemiology who have completed one year of course work and identified a thesis project and a training faculty mentor, are eligible for this fellowship. The number of strong pre-doctoral candidates always exceeds the number of available fellowships. Resumes of interested first year students are forwarded to the track co-directors to identify well-qualified and eligible candidates, and work with them to identify a faculty mentor and project, when necessary. The student then completes the STD/AIDS fellowship application for review at the next meeting of the track directors. Trainees form a thesis committee, often containing more than one Public Health Track faculty member. The student's committee helps with the development of a formal research proposal (based on the NIH PHS 398 Research Plan), monitors the student's progress yearly (making recommendations for additional course work if needed), and administers the qualifying exam and final defense. Three first-author publications in peer-reviewed journals are expected. Pre-doctoral students generally obtain their PhD within 4 to 5 years and are supported by this training grant for 3 years.

Post-doctoral MPH candidates also establish a thesis committee, write a research proposal and a thesis prepared for publication. Post-doctoral fellows receive at least 2 years on this training grant. They and their faculty mentors are expected to seek independent funding to support the third and subsequent years of training. However, because course work for the MPH degree may delay initiation of research for up to 9 months, application for independent funding may not be feasible for some trainees until the third year of training.

Didactic MPH/PhD Curriculum and additional seminar opportunities: All trainees participate in the STD and AIDS Core curriculum, and take 3-4 quarters of epidemiologic methods, 3 quarters of epidemiology seminar, and at least 1 quarter (MPH students) or 4-5 quarters (PhD students) of biostatistics. For post-doctoral trainees seeking an MPH in epidemiology, didactic courses occupy most of the first training year, with introductory/overview courses in the Summer quarter and formal courses attended October through June. Three courses, conducted jointly by the Departments of Medicine (Infectious Diseases), Epidemiology, and Biostatistics, were specifically developed for trainees in this track: "HIV/AIDS: A Multidisciplinary Approach" (Epidemiology 530, 2 credit hours) also now taken by many trainees from other tracks; "Principles of Epidemiology and Biostatistics for STD/HIV Research" (Epidemiology 590A, 2 credit hours); and "Methodologic Issues in STD/HIV Research" (Epidemiology 590B, 2 credit hours).

Both pre- and post-doctoral trainees participate in: Epidemiology Seminar (bi-weekly), Biostatistics Seminar (weekly), and the HPV Journal Club and Seminar Series (monthly). Trainees present results from their MPH or PhD research at one of these meetings.

Faculty: 22 faculty members participate in the Epidemiology and Public Health Track, including 11 training faculty and 11 resource faculty members. Faculty and trainees in this track always work closely with those in other tracks, especially the International and Sociobehavioral Research tracks.

Research Training Opportunities: The UW graduate program in epidemiology teaches multidisciplinary approaches to the design and conduct of studies in diverse populations. Students involved in STD and HIV research projects have benefited enormously from learning how to work with scientists from other disciplines and with community-based organizations. A short synopsis of research of the 8 senior and 3 new training faculty is provided below:

• Handsfield, Hunter, MD. Dr. Handsfield directs the STD Control Program, Seattle King County Department of Public Health, and studies the clinical epidemiology, treatment, and prevention of STD, with emphasis on chlamydial infection, gonorrhea, syphilis, genital herpes, the influence of traditional STDs on transmission of HIV, and the clinical epidemiology of STDs in men who have sex with men (MSM). Dr. Handsfield collaborates with Drs. Golden, Holmes and Hughes on new approaches to STD partner management and peer outreach interventions, including two ongoing CDC-funded randomized trials of different approaches to sex partner management, with recent expansion to address new, city-wide approaches to partner management and integration of contraceptive services into STD-outreach. Formative research on behavioral intervention for HIV-infected and uninfected MSM is ongoing.
  
  
• Koutsky, Laura, PhD. Dr. Koutsky's research concerns acquisition, natural history, and prevention of HPV infection and the prevention of HPV-related ano-genital neoplasms. Ongoing projects include studies of (1) per partner and per act risk factors for HPV, (2) frequency of long-term, low-level infection by the same HPV type(s), (3) epidemiology of genital HPV infection among men, (4) effectiveness, and cost-effectiveness of new technologies for cervical cancer screening, (5) HPV sentinel surveillance, (6) an HPV knowledge, attitudes and behavior survey, & (7) design and conduct of randomized trials of HPV vaccines.
  
  
• Fleming, Tom, PhD. Dr. Fleming directs the Biostatistics/Epidemiology Core of the UW CFAR, has worked locally and nationally on HIV vaccines with Dr. Corey; has collaborated with Drs. Kreiss and Holmes on clinical research from the International AIDS Research Program, and has served as chair of the DSMB of Phase III randomized trials evaluating the role of breast-feeding in perinatal HIV transmission and the microbicide nonoxynol-9 in sexual transmission.
  
  
• Golden, Matt MD, MPH. Dr. Golden's research focuses on the role of sexual networks in STD transmission and on the development of new approaches to STD partner notification (PN) for the control of STD. Two ongoing randomized trials are assessing different approaches to PN for bacterial STD in heterosexuals and men who have sex with men. These studies, as well as others, collect sexual network data that will be used to parameterize mathematical models of STD transmission.
  
  
• Hitti, Jane, MD. Dr. Hitti's research has focused on infectious and inflammatory correlates of preterm labor working closely with Drs. Eschenbach and Patton. She also has a strong research interest in the impact of HIV infection on women's health, and collaborates with Drs. Coombs and Collier in research investigating bacterial and inflammatory up-regulation of genital HIV-1.
  
  
• Hughes, James, PhD. Dr. Hughes collaborates with several faculty members in this track and has helped many trainees with the design and analysis of their research projects, particularly inadaptation of existing methods and development of new methods for dealing with outcomes measured imperfectly.
  
  
• Kitahata, Mari, MD, MPH. Dr. Kitahata Directs Health Services Research and Development for the HMC AIDS Program and the Center for AIDS Research at the University of Washington. She also directs HIV/AIDS research at the Center for Health Studies, Group Health Cooperative. Current research includes: the effect of physicians' experience with HIV disease on patient outcomes; caring for persons with HIV infection in a managed care environment; the effect of computerized interventions to promote evidence-based guidelines for antiretroviral therapy and the prevention of opportunistic infections through adherence to standards of HIV/AIDS care; patterns of service utilization and cost of HIV care; cost-effectiveness of treatment innovations; and models of health care delivery.
  
  
• Marrazzo, Jeanne MD, MPH. Dr. Marrazzo's research on bacterial vaginosis emphasizes epidemiologic studies of risk factors for transmission of BV during sex between women, and involves a randomized trial of recolonizing the vagina with H2O2-producing lactobacilli to prevent recurrence of BV.
  
  
• Wald, Anna, MD, MPH. Dr. Wald's research on the epidemiology and natural history of genital herpes infection aims to 1) characterize the biology and epidemiology of HSV acquisition and transmission; 2) determine the acceptability and psychosocial consequences of serologic testing for HSV-2 in various populations; 3) assess predictors of genital HSV shedding; 4) evaluate the impact of HIV infection on genital HSV-2 infection, the ability of HAART to restore immune control of HSV infection, and the effect of anti-HSV chemotherapy on HIV shedding from genital herpes lesions.
  
  
• Wasserheit, Judith, MD. Dr. Wasserheit research is focused on developing and evaluating effective HIV vaccines for domestic (United States) and international settings. She directs and coordinates the NIH HIV Vaccine Trials Network.

• Community-Based Public Health Preceptorships: These preceptorships are arranged individually, matching the trainees' career goals and interests with those of the preceptors, to transfer practical skills. For example, a trainee can learn to work with state or county-level public health databases derived from STD or HIV morbidity reports or with Group Health Cooperative data, via preceptorships with resource faculty; and can participate in community-based public health measures to prevent HIV with Drs. Handsfield, Golden, or Wood.
  
  
• Competition for CDC Public Health STD Fellowships: This CDC program provides 2 year's funding to learn about national STD control efforts, and includes up to 6 months at CDC working with an established CDC STD investigator.